肺泡复张可提高麻醉期间肺的通气效率。

Alveolar recruitment improves ventilatory efficiency of the lungs during anesthesia.

作者信息

Tusman Gerardo, Böhm Stephan H, Suarez-Sipmann Fernando, Turchetto Elsio

机构信息

Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina.

出版信息

Can J Anaesth. 2004 Aug-Sep;51(7):723-7. doi: 10.1007/BF03018433.

DOI:10.1007/BF03018433

PMID:15310643

Abstract

PURPOSE

The goal of this study was to analyze the effect of positive end-expiratory pressure (PEEP), with and without a lung recruitment maneuver, on dead space.

METHODS

16 anesthetized patients were sequentially studied in three steps: 1) without PEEP (ZEEP), 2) with 5 cm H(2)O of PEEP and 3) with 5 cm H(2)O of PEEP after an alveolar recruitment strategy (ARS). Ventilation was maintained constant. The single breath test of CO(2) (SBT-CO(2)), arterial oxygenation, end-expiratory lung volume (EELV) and respiratory compliance were recorded every 30 min.

RESULTS

Physiological dead space to tidal volume decreased after ARS (0.45 +/- 0.01) compared with ZEEP (0.50 +/- 0.07, P < 0.05) and PEEP (0.51 +/- 0.06, P < 0.05). The elimination of CO(2) per breath increased during PEEP (25 +/- 3.3 mL.min(-1)) and ARS (27 +/- 3.2 mL.min(-1)) compared to ZEEP (23 +/- 2.6 mL.min(-1), P < 0.05), although ARS showed larger values than PEEP (P < 0.05). Pa-etCO(2) difference was lower after recruitment (0.9 +/- 0.5 kPa, P < 0.05) compared to ZEEP (1.1 +/- 0.5 kPa) and PEEP (1.2 +/- 0.5 kPa). Slope II increased after ARS (63 +/- 11%/L, P < 0.05) compared with ZEEP (46 +/- 7.7%/L) and PEEP (56 +/- 10%/L). Slope III decreased significantly after recruitment (0.13 +/- 0.07 1/L) compared with ZEEP (0.21 +/- 0.11 1/L) and PEEP (0.18 +/- 0.10 1/L). The angle between slope II and III decreased only after ARS. After lung recruitment, PaO(2), EELV, and compliance increased significantly compared with ZEEP and PEEP.

CONCLUSION

Lung recruitment improved the efficiency of ventilation in anesthetized patients.

摘要

目的

本研究的目的是分析呼气末正压（PEEP）在有无肺复张手法的情况下对死腔的影响。

方法

对16例麻醉患者按三个步骤进行序贯研究：1）无PEEP（零PEEP，ZEEP）；2）5 cmH₂O的PEEP；3）在肺泡复张策略（ARS）后给予5 cmH₂O的PEEP。通气保持恒定。每30分钟记录一次二氧化碳单次呼吸试验（SBT-CO₂）、动脉氧合、呼气末肺容积（EELV）和呼吸顺应性。

结果

与ZEEP（0.50±0.07）和PEEP（0.51±0.０6）相比，ARS后生理死腔与潮气量的比值降低（0.45±0.01，P<0.05）。与ZEEP（23±2.6 mL·min⁻¹，P<0.05）相比，PEEP（25±3.3 mL·min⁻¹）和ARS（27±3.2 mL·min⁻¹）期间每呼吸周期的二氧化碳清除量增加，尽管ARS的值高于PEEP（P<0.05）。与ZEEP（1.1±0.5 kPa）和PEEP（1.2±0.5 kPa）相比，复张后动脉血二氧化碳分压与呼气末二氧化碳分压差值降低（0.9±0.5 kPa，P<0.05）。与ZEEP（46±7.7%/L）和PEEP（56±10%/L）相比，ARS后斜率II增加（63±11%/L，P<0.05）。与ZEEP（0.21±0.11 1/L）和PEEP（0.18±0.10 1/L）相比，复张后斜率III显著降低（0.13±0.07 1/L）。仅在ARS后，斜率II和III之间的夹角减小。肺复张后，与ZEEP和PEEP相比，动脉血氧分压、EELV和顺应性显著增加。